Forging ahead: Linking health and behavior to improve quality of life in older people

This chapter will focus on conceptual and methodological issues related to health promotion/disability prevention for older people. The first section will begin with a discussion of why older people, as compared to younger persons, are not traditionally seen as targets of health promotion efforts. In recent years several national working groups have been established to examine how older people's health and functioning can be improved. Their objectives and recommendations for older Americans will be reviewed. The second section will address the conceptual framework underlying health and behavior research supported by the National Institute on Aging. The movement from correlational studies to studies of basic mechanisms linking health and behaviour will be discussed, with particular attention to interactions with aging processes. Examples of health and behavior research representing these processes will be presented as well as methodological issues in the measurement of health and functional outcomes for older people. Measurement of quality of life in the cognitively impaired is seen as especially difficult. The third section will review several common themes emanating from these research studies. These include attention to a life course perspective, variability in aging processes, alternative research approaches, and intervention strategies for both initiating and maintaining recommended behavioral changes. A fourth section will review current areas of investigation at the National Institute of Aging. Successful intervention strategies in both community and institutional settings will to presented. These include: (1) a comprehensive behavioral and environmental falls prevention program which has been shown to reduce falls in the community; (2) a health education program to increase older women's use of cancer-related health practices; and (3) behavioral strategies for reducing incontinence in nursing homes. A new NIA initiative on special care units for persons with dementia will also be discussed. The fifth and final section will deal with issues involved in the translation of research into policy and practice. Approaches for increasing the relevance of research to policymakers will be discussed.     

Impact of health and fitness-related behavior on quality of life

While the relationships between (a) health behavior and health status and (b) health status and perceived quality of life (QOL) have received some attention, the association between health behaviors and QOL has not been determined. The primary objective of this study was to assess the effects of health behaviors on QOL that are independent of the effects of health status. A sample of approximately 5 000 randomly selected U.S. Navy personnel was split into halves and analyses performed on each to establish the replicability of the findings. At step one of a multiple regression procedure, health status variables were forced into the equation; next, health behavior variables were entered. As expected, the block of health status variables was significantly related to QOL: self-assessed health and fitness status and lower reporting of physical symptoms accounted for 16% and 18% of the variance in QOL for the two subsamples. After controlling for health status, two behavioral measures made unique contributions to the prediction of QOL: behaviors related to avoiding unnecessary risks as a driver or pedestrain and avoiding or minimizing accidents. Wellness maintenance behaviors also were associated with QOL in one subsample. After controlling for health status, health behavior measures contributed an additional 11% and 6% of the explained variance in QOL for the two subsamples. Results indicate that health behaviors influence QOL independently of health status.     

Gender differences in health promotion behaviors and quality of life among community-dwelling elderly

The differences of basic attributes, health promotion behaviors, and quality of life between elderly males and females in Taiwan were compared. Several scales were used to examine the gender differences and the factors associated with quality of life. Regression analysis revealed that gender, education level, depression level, and healthy diet were key factors influencing the overall quality of life. The education level of females was lower, and their depression level was higher; however, females had healthier diets. With regards to their satisfaction in the quality of life, elderly males scored higher than females in both the physical and psychological domains.     

HIV testing in pregnancy: Using women's voices to inform policy

BackgroundIn Canadian provinces with opt-out policies for maternal HIV screening, pregnant women are told HIV screening is routine and are provided with the opportunity to refuse. In Newfoundland and Labrador an opt-out screening policy has been in place since 1997.PurposeThis research study aimed to (1) obtain an increased understanding of the information women receive about HIV/AIDS during the opt-out screening process and (2) to advance the policy related dialogue around best practices in HIV screening within the province of Newfoundland and Labrador.MethodsTwelve women who were between 14 and 35 weeks gestation participated. Interviews were transcribed verbatim and a thematic analysis was carried out.FindingsThe major themes are that women have difficulty obtaining clear information about maternal HIV screening, are often not told they have the right to refuse maternal screening, and experience paternalism from physicians.ConclusionWe recommend that physicians and other health care providers in be reminded that that current opt-out testing requires women's consent and that women must be given the option to refuse the test.     

The quality of life in Australia

This paper outlines a long term project on the quality of life in Australia and presents some initial survey data. The long term project is intended (1) to find which domains of life most affect the perceived well-being of Australians and the values/satisfactions people wish to achieve in these domains (2) to propose policy programs designed to enhance satisfaction with particular domains and (3) to assess the political feasibility of proposed programs. Policy programs intended to enhance satisfaction are termed positive welfare programs to distinguish them from conventional compensatory welfare programs. The survey data analysed here (national sample, N=679) deal with the satisfactions and dissatisfactions of Australians, the correlates of perceived well-being and the links between domains and values. Perceived well-being is measured by Andrews and Withey's Life-as-a-whole index and Bradburn's Affect Balance scale. Satisfactions are measured on a 9 point modified version of Andrews and Withey's delighted-terrible scale. Readers familiar with American, British and Canadian findings will find the results reported here broadly similar. However, the linkage between people's sociological characteristics and their satisfaction levels appears to be exceptionally weak in Australia, which tends to confirm the view that Australia is a comparatively unstratified society.     

Leisure and quality of life in an international and multicultural context: what are major pathways linking leisure to quality of life?

This paper aims at advancing the conceptualization of leisure as a contributor to quality of life (QOL) in an international and multicultural context, based on an extensive and critical review of literature on leisure and QOL from a global, international perspective. Given the central role of culture in conceptualizing this notion, this paper gives attention to various cultural contexts world-wide. To illustrate the diversity of our societies, examples are introduced specifically from three culturally unique contexts in this paper – i.e., Asian, Middle-East, and Indigenous contexts. Also, some examples are drawn from other cultural groups in global and international contexts, particularly, in non-western contexts. Then, the final section of this paper aims at integrating and synthesizing the knowledge gained from this review to develop a tentative/working proposition about how leisure can contribute to QOL from international and cross-cultural perspectives. Specifically, based on such integration, this paper identifies and describes major pathways linking leisure to QOL. Overall, an overarching theme common to almost all cultural contexts examined appears to be the role of leisure-like activities as a context or space for creating meanings which then help to promote the quality of people’s lives. Major pathways or mechanisms that can facilitate meaning-making and life-quality-enhancement highlighted in this review include: (a) positive emotions and well-being experienced from leisure, (b) positive identities and self-esteem gained from leisure, (c) social and cultural connections and a harmony developed through leisure, and (d) leisure’s contribution to learning and human development across the life-span. Also, emphasized in this paper is the role of leisure as a context for realizing and utilizing human strengths and resilience. It is important, however, to stress that in people’s quest for a meaningful life, the benefits of meaning-making through leisure involve both “remedying the bad” and “enhancing the good,” as shown throughout this paper. Despite these benefits, we should not ignore that leisure experiences are socially and culturally constructed and shaped by the inequalities of society. Thus, the reality of power imbalance and inequalities should be acknowledged and appropriately addressed socially, culturally, and politically. Particularly, providing culturally relevant and meaningful leisure opportunities for less privileged population groups world-wide is clearly a top priority.     

Evaluating the quality of life in Belgium

This paper deals with the evaluation of social welfare inequalities in order to establish a qualitative growth model for Flanders. As a base for the enquiry, quantitative, objective result indicators are chosen. The various quantified components are dealt with separately and different methods of aggregation are discussed. 32 indicators are selected on the basis of a specific definition of social welfare and taking account of the difficulties of collecting certain information. The indicators are aggregated in three different ways and in two stages: first per component for each region and secondly per region. The results show that major variations in the components are weakened by the aggregation and further that the different aggregation methods lead to only small differences. As a general conclusion one can speak of a regional homogeneity in Belgium.     

Personality and quality of life

The present study investigated a possible association between personality, mental absorption and quality of life (QOL) in a sample of young males (N=411). Mental absorption was assessed with Tellegen's Absorption Scale (ABS). Using a 6 dimensional QOL-scale we found the Millon Behavior Health Inventory (MBHI) dimensions Basic coping style, Psychogenic attitudes, Psychosomatic correlates and Prognosic indices, to be firmly related to QOL, explaining 44% of the variance of a QOL scale which was derived through factor analysis. Mental absortion was weakly related to QOL. The discussion revolves around the relationship between personality and perceptual style, health report behavior and personality as possible biasing factor in evaluative QOL-investigations.     

The impact of federal aid on the quality of life: The case of infant health

Federal grants-in-aid have been a major device for stimulating new programs for improving the quality of life in the United States. This paper assesses the impact of one such grant-in-aid (Maternal and Child Health Services) on improvements in infant health in the American states in the 1950–1964 period. The analysis indicates that how much a state's Maternal and Child Health Services grant was increased or decreased had no systematic overal impact on later changes in that state's infant, neonatal, and fetal mortality indicators. In addition, such grant changes had no major systematic impact when controlling for per capita income, changes in per capita income, population, innovation tendencies, and administrative professionalism.     

Cultural bias in ratings of perceived life quality

The results of comparative surveys have demonstrated great differences of perceived life quality. Yet there is doubt whether these differences mean that people are really more satisfied in one country than in another. It is generally believed that the responses are distorted by factors such as language, familiarity with concepts like satisfaction, and social desirability pressures. Though often alleged, the truth of these charges has not yet been demonstrated empirically. Ostroot & Snijder (1985) now claim to have demonstrated that about 40% of the difference in satisfaction between the French and Americans is due to ‘cultural bias’: in particular to a rosier outlook of the latter. Yet their arguments labor under two defects: Firstly, their use of the word ‘bias’ is misleading. They do not demonstrate any discrepancy between avowed satisfaction and ‘true’ satisfaction. Speaking of a ‘cultural effect’ would be more appropriate. Secondly, Ostroot & Snyder do not demonstrate that the greater satisfaction of Americans is due to a rosier outlook on their part. The data do not allow the conclusion that Americans hold a rosier view than the French, nor that such a view is responsible for their greater satisfaction.     

Religiosity and quality of life in South Africa

Using nationally representative survey data, this paper explores the relationship between religiosity and quality of life. Three indicators of religiosity are used: (i) frequency of attendance at religious services or meetings, (ii) orthodoxy of beliefs in relation to Biblical teachings and (iii) religious denomination. Quality of life (QoL) is measured in terms of (i) household access to modern conveniences, (ii) self-assessed life satisfaction and (iii) level of satisfaction with government institutions. The data shows a significant but not very strong statistical relationship between religiosity and QoL. People who attend religious meetings most frequently and who hold the most orthodox religious views are thus more likely to have access to modern conveniences and to be satisfied with their lives. Satisfaction with government, however, tends to be highest amongst nominally religious people and lowest amongst both the most orthodox and the least religious.     

Perceived quality of life in a centre-periphery framework

Centre-periphery relationships have generally been a characteristic of every level of development regardless of the type of political economy. Usually, the centre is well-developed, and has a higher level of facilities and infrastructure, while shortages and a poorer infrastructure, sometimes bordering on marginality, characterize the periphery. In the province of Alberta in Canada, the Edmonton—Calgary corridor represents the centre while the rest of the province, especially Northern Alberta characterizes the periphery.Do people in the centre necessarily evaluate the quality of their lives differently from the people in the periphery? Within the periphery region, do the people on the periphery of the periphery evaluate their lives differently from those in the centre of the periphery?These issues are addressed using data from the Edmonton Area Studies and field work conducted in the High Prairie region of Northern Alberta between December, 1985 and January, 1986.     

Self-other orientations and quality of life

A theory, related measures, and series of studies are presented here which proffer a new approach to the study of quality of life. The approach is phenomenological. The quality of life evaluation is assumed to be in the eye of the experiencer. To facilitate the experiencer's communication, a non-verbal technique of measuring the personal meaning of events and environments is employed. A series of studies are described which emerge from this framework dealing with alienation; gain or loss of social status; love, marriage, and parenthood; and transitional states. Finally new uses of the approach are proposed.     

Social indicators of perceived life quality

Modern societies in both developing and developed countries have real and legitimate concerns about the enhancement, maintenance, and redistribution of individual well-being. Indicators of perceived well-being provide direct measures of what societies are trying to achieve, permit cross-sector comparisons, can indicate the adequacy of coverage of ‘objective’ indicators, and can contribute to social policy making. in both the long and short run. Some commentators, however, have suggested perceptual indicators suffer from methodological weaknesses associated with their validity, interpretability, completeness, and utility. Each of these possible weaknesses is addressed in some detail. New research evidence and certain philosophical perspectives are presented, and it is concluded that none of these presumed weaknesses is sufficient to invalidate the development and use of perceptual indicators. Suggestions are made concerning methodological research needed to support the development of indicators of perceived well-being. It is noted that the materials and results developed in the author's research on Americans' perceptions of life quality may be useful for suggesting approaches to the development of indicators of perceived life quality relevant to other cultures.     

Feminism and the quality of life

A measure of feminism is introduced, and a case is made for the acceptability of its levels of reliability, criterion-related, content, construct and discriminant-validity. Feminism is shown to be related to such features of the quality of life as happiness and being a good person. Survey results are reported from a sample of 431 members of the Canadian Research Institute for the Advancement of Women and 413 undergraduate women from the University of Guelph.     

Genetics and the quality of life

Thanks to recent innovations in medicine, it is now possible to detect many so-called genetic diseases' before birth. Consequently, there is a growing movement amongst the medical fraternity advocating genetic counseling: the detection and abortion of diseased fetuses, before birth. This paper considers the implications of this practice on the general quality of life, examining in some detail cost-benefit analyses of the most extensive screening and counseling programme to date, the Kennedy Institute project aimed at reducing the numbers of North American Jewish children born with Tay-Sachs disease. It is argued that although genetic counseling clearly does hold prospects for improving the quality of life in some respects, nevertheless it raises many questions (e.g. to do with minorities and the poor), and care must be taken lest-stampeded by the enthusiasms of medical researchers-overall the quality of life declines.     

A comparative approach to assessing the quality of life of intercollegiate athletes

Although concerns have frequently been raised recently regarding the quality of life of intercollegiate athletes, information is seldom available on which college and university administrators can base policy decisions. Particularly lacking are studies that provide administrators with assessments of their own athletics programs relative to athletics programs at other institutions. We describe here a method we used in conducting a comparative evaluation of the status of student-athletes at a large public university, involving comparisons of student-athletes at this university to student-athletes at a subset of the institutions that participated in the 1987–88 National Study of Intercollegiate Athletes. By utilizing existing data sets to construct comparison samples, relative assessments of the status of student-athletes at a given institution can be performed without the excessive costs of gathering data on student-athletes at comparison institutions. Techniques employed in data collection and analysis are discussed as well as the format of the report in which the findings of the study were presented.     

Regression analysis of regional quality of life

A regression procedure, using survey data on individual's stated preferences for communities, is used to calculate an index of ‘quality of life’. The survey instrument is extraordinarily simple, asking only for limited information about the subset of communities most well-known to respondents. The index is based upon an assumption about the distribution of the errors individuals make in perceiving the true, underlying index. The index is computed from dummy variables and is shown to have nice properties, including invariance to data ordering and (with full information) constant and equal standard errors associated with relative interplace index values. The index is estimated for a case study of 52 Pennsylvania counties.     

Enhancing quality of life in the population at large

The purpose of this review was to identify and discuss emerging issues in the literature on quality of life in the population at large. Interest in the topic has developed from a desire to compare cultural units, to develop normative data, and to establish programs to enhance quality of life. An attempt is made to impose some empirical and theoretical order on the numerous definitions and measures of quality of life, that have been used with the population at large. A taxonomy is provided that outlines the relationship among measures of quality of life. Following this discussion, studies identifying those factors that may influence quality of life in the population at large are examined, and a model linking these factors is proposed. The model includes Personal/Dispositional Factors, Biosociophysical Environmental Factors, General and Domain Specific Skills, Affective Tone, Social Support and Cognitive Appraisal as they relate to Quality of Life. Potential Quality of Life enhancement programs are considered with respect to their orientation (Person, Environment) and their mode of delivery (One on one, Education, Legislation). Recommendations concerning measures that can be implemented to enhance quality of life in the population at large are made.